Disaster Medicine and Public Health Preparedness最新文献

The characterization of ionizing radiation as a human carcinogen affecting most organs was a major achievement in epidemiological studies. Although high-dose or high-dose rate radiation effects are well established, the health impacts of low-dose or low-dose rate exposure (<100 mSv) remain controversial, which brings significant social attention and scientific inquiry. This paper outlined the current status and future plans of radiation epidemiology in Korea, focusing on research developments based on legal grounds, including the Korean Radiation Workers Study (KRWS) and epidemiological studies of aircrews and residents near nuclear facilities. The KRWS encompasses a large cohort of approximately 200 000 current and retired radiation workers, integrating individual dose data collected since 1984 with national health datasets to assess cancer and non-cancer risks. Initial findings showed a decrease in overall cancer incidence among workers compared to the general population, though thyroid cancer rates were higher, possibly due to increased screening. In 2023, new studies on aircrews and residents near nuclear facilities began, including systematic reviews and meta-analyses of existing studies, as well as ecological analyses of regional cancer risks. Despite challenges in low-dose research, these large-scale Korean studies using comprehensive national health data are expected to provide scientific evidence on the effects of low-dose radiation and address public concerns about radiation exposure.

Objectives: To estimate and improve Ukraine's health sector's preparedness to respond to radiation and nuclear emergencies.

Methods: Field expert assessments and analytical methods were used.

Results: In September 2022, the WHO evaluation mission to Ukraine visited several critical regions to review the current state of health sector preparedness for a nuclear emergency and revealed many defects and items for improvement. The provision of radiation control equipment was considered for ambulance teams, admissions departments/emergency departments in designated hospitals, and tertiary level hospitals, and for National and Regional Public Health Laboratories. For cases of mass casualty, WHO procured 20 decontamination tents for the country. Training courses for medical specialists and decision-makers were launched.

Conclusions: The WHO mission was crucial in assessing the overall state of preparedness for CBRN threats and directing forces and resources to improve it. Donor assistance in the form of equipment for dosimetric monitoring and diagnostics of emergency-related disorders contributes to improving the preparedness of the health system of Ukraine to an adequate response to the threats of radiation and nuclear emergencies.

Objectives: Disaster medicine (DM) prepares health care professionals to manage emergencies caused by significant societal disruptions. Training recent graduates and final-year students is an essential element of disaster preparedness. This review aims to examine the use of Virtual Simulation (VS) in undergraduate students' DM training.

Methods: The research team searched Scopus, PubMed, WOS, and Scielo. The team followed the 6-step approach described by Mak to conduct Scoping Reviews. We identified 262 reports, and 17 articles met the inclusion criteria. We extracted and analyzed data, focusing on educational settings, professions involved, and intervention characteristics. The report followed PRISMA guidelines.

Results: The implementation of VS in DM training has been geographically concentrated, with most studies focused on nursing education. Most programs use virtual reality, with limited augmented or mixed reality integration, principally in nursing students. The training focused primarily on triage, disaster preparedness, evacuation, decontamination, improving knowledge retention, self-confidence, and decision-making.

Conclusions: Although VS has effectively enhanced technical skills and disaster preparedness, its use remains limited in undergraduate health education. Further research is needed to expand its application in interprofessional and non-nursing contexts, with deliberate practice principles to maximize efficiency. Integrating VS into community training can reduce costs and enhance large-scale emergency response.

Disaster medicine (DM) prepares health care professionals to respond to emergencies that disrupt society. Training recent graduates and final-year students is crucial for preparedness, yet traditional methods often fail to provide hands-on experience. To bridge this gap, a scoping review explored the role of Virtual Simulation (VS) in DM training for undergraduate students. A team of 6 experts analyzed 262 studies, narrowing down to 17 relevant articles. Results revealed that VS is predominantly used in nursing education, focusing on triage, preparedness, evacuation, and decision-making key components in protecting both hospital resilience and community well-being. Programs largely relied on virtual reality, with minimal integration of augmented or mixed reality. Despite its potential to enhance skills and confidence, VS training seldom applied deliberate practice principles, limiting its effectiveness. Expanding VS adoption across health professions and incorporating deliberate practice could improve disaster preparedness, optimize resource use, and enhance community resilience, underscoring the need for further research and program development.

Objectives: To assess interagency emergency response capabilities for radiological threats through a tabletop exercise (TTX) simulating a nuclear power plant accident, with focus on communication protocols, patient referral pathways, and public information management in Ukraine's current security context.

Methodology: A structured 3-day TTX was conducted in September 2024 by the WHO Ukraine Country Office, simulating a cooling system failure at a fictional North-West Nuclear Power Plant. Twelve organizations participated, including regional health authorities, emergency services, and international partners. The exercise employed a progressive scenario that injects testing accident notification, media management, medical response, and evacuation procedures. Performance was evaluated using structured criteria (Achieved, Partially Achieved, Not Achieved) across predefined indicators.

Results: The exercise identified critical preparedness gaps including the absence of regular radiological-nuclear emergency drills in regions without nuclear facilities, challenges in potassium iodide procurement and distribution, staff hesitancy due to inadequate insurance coverage, and lack of standardized decontamination procedures. Communication protocols functioned effectively, though coordination delays were noted. Patient referral pathways required strengthening, particularly for contaminated casualties.

Conclusions: While Ukraine demonstrates functional emergency response frameworks, specific radiological preparedness requires enhancement. Regular multiagency drills, improved staff protection policies, standardized decontamination protocols, and robust public information systems are essential for effective radiological emergency response.

Objective: This study explores how loneliness affects earthquake risk perception and preparedness behaviors among older adults in Japan. Aging is often accompanied by increased vulnerability to natural disasters, and loneliness is hypothesized to compromise effective preparedness. Using the Japanese Older Adult Preparedness Model (JOAPM), which integrates the Protective Action Decision Model (PADM) and cultural context, we examine how loneliness influences both perceived earthquake risk and protective behaviors.

Methods: An online survey conducted in April 2024 gathered responses from adults aged 55 and older across 4 earthquake-prone Japanese prefectures. Measures included demographics, disaster experience, loneliness (UCLA Loneliness Scale), risk perception, and preparedness actions such as household adjustments. Regression and mediation analyses assessed the direct and indirect effects of loneliness on preparedness.

Results: Findings show that loneliness has a significant negative direct effect on disaster preparedness. However, it also slightly increases risk perception, which in turn has a positive relationship with preparedness behaviors, suggesting a modest indirect pathway. Overall, the direct negative effect of loneliness outweighs the indirect benefit.

Conclusion: The results highlight the complex role of psychosocial factors in disaster readiness, suggesting that interventions should address information dissemination, self-efficacy, and the emotional isolation experienced by older adults in high-risk areas.

Objective: Evaluate and improve the accuracy of disaster triage decisions for pediatric patients among clinicians of various training levels using the Sort, Assess, Life-Saving Intervention, Treatment/Transport (SALT) triage system.

Methods: We used an online pediatric disaster triage module to evaluate and improve accuracy of triage decisions. During a pre- and post-test activity, participants triaged 20 fictional patients. Between activities, participants completed a didactic covering concepts of disaster triage, SALT triage, and pediatric limitations of triage systems. We assessed accuracy and improvement with non-parametric tests.

Results: There were 48 participants: 27 pediatric emergency medicine attendings (56%), 9 pediatric emergency medicine fellows (19%), 12 pediatric residents (25%). The median (interquartile range [IQR]) pre-test percent accuracy across all participants was 75 (IQR 65-85). Attendings scored higher than residents 80 (IQR 73-88) compared to 60 (IQR 55-65, P < 0.01) but not significantly higher than fellows 75 (IQR 70-85, P = 0.6). For the 44 participants who completed both the pre- and post-test, median score significantly improved from 75 (65-85) to 80 (75-90), P < 0.01.

Conclusions: The accuracy of triage decisions varies at different training levels. An online module can deliver just-in-time triage training and improve accuracy of triage decisions for pediatric patients, especially among pediatric residents.

Background: The COVID-19 pandemic significantly impacted Saskatchewan, resulting in high per capita case counts and COVID-19-related deaths. While vaccination mandates have been a key strategy to control the pandemic, their impact in Saskatchewan remains poorly documented. This study assessed the effect of COVID-19 vaccine mandates on the incidence of COVID-19 cases and deaths in Saskatchewan during the first year following vaccine rollout.

Methods: A single-group interrupted time series analysis with multiple intervention points was conducted using aggregated daily COVID-19 incidence and mortality rates as outcome variables. The models accounted for confounding effects of daily total vaccine doses administered and public health countermeasures, including the stringency index and economic support index, from April 1, 2020 to January 20, 2022. Average daily COVID-19 incidence and mortality rates were estimated for the pre-vaccine rollout period (April 1 to December 14, 2020), and the post-rollout period (December 15, 2020 to January 20, 2022). In addition, nine supplementary initiatives were introduced during the implementation phase. All estimated effects reflected cumulative changes in trend relative to the pre-vaccination period.

Results: Cumulatively, COVID-19 incidence increased faster than the pre-vaccination trend, likely driven by successive variant surges from wild-type to Omicron, while COVID-19-related deaths remained stable across the same period. The implementation of vaccine rollout, prioritization of vaccines for high-risk populations, and proof-of-vaccination policy were effective in reducing daily COVID-19 incidence and deaths in Saskatchewan. Economic support and an increased number of daily vaccine doses administered were also associated with an improved provincial COVID-19 response. Conversely, surges in COVID-19 incidence and deaths occurred following the introduction of the centralized virtual booking system and booster doses. These surges may reflect accessibility challenges, increased testing, emergence of immune-escape variants, relaxation of public health measures before achieving herd immunity, and waning immunity over time.

Conclusions: Economic support, policy measures, and vaccination efforts played important roles in managing public health crises, hence the need for an integrated approach to managing public health crises. However, temporary surges following certain interventions underscore the need for accessible, adaptable strategies that account for variant emergence, immunity waning and public adherence.